Regional Gastrointestinal Consultants

Crohn's Disease

Crohn's Disease

Crohn’s Disease

Overview

Crohn’s Disease is a chronic inflammatory disease of the gastrointestinal tract which can affect any part of the gut, from the mouth to the anus, but commonly affects the small and large intestine. It is one of the group of inflammatory bowel diseases (IBD) which run in families. Crohn’s disease and ulcerative colitis are both associated with certain genetic diseases. However, the cause of IBD is unknown.

Exclusion of infective causes of diarrhea and bleeding is important and hence stool culture and examination may also be performed. A full blood count may also be done to see if the patient is anemic because of low iron, folate or vitamin B12, plus to look for signs that an inflammatory process is occurring.

Crohn’s Disease increases the risk of colon cancer due to the constant inflammation and healing. Smokers are at an increased risk of developing Crohn’s disease.

Most commonly, Crohn Disease occurs in the last portion of the small intestine (ileum) and in the large intestine, but it can occur in any part of the digestive tract, from the mouth to the anus and even in the skin around the anus. When Crohn Disease affects the colon, it is called Crohn Colitis. Crohn Disease affects

Segments of diseased bowel are sharply demarcated from adjacent normal bowel (called skip areas), hence the name regional enteritis.

  • About 35% of Crohn Disease cases involve the ileum alone (ileitis).
  • About 45% involve the ileum and colon (ileocolitis), with a predilection for the right side of the colon.
  • About 20% involve the colon alone (granulomatous colitis), most of which, unlike ulcerative colitis (UC), spare the rectum.
  • Occasionally, the entire small bowel is involved (jejunoileitis). The stomach, duodenum, or esophagus is clinically involved only rarely, although microscopic evidence of disease is often detectable in the gastric antrum, especially in younger patients. In the absence of surgical intervention, the disease almost never extends into areas of small bowel that are not involved at first diagnosis.

The two primary types of inflammatory bowel disease (IBD) are:

  • Crohn Disease
  • Ulcerative Colitis

These two diseases have many similarities and sometimes are difficult to distinguish from each other. However, there are several differences. For example, Crohn Disease can affect almost any part of the digestive tract, whereas ulcerative colitis almost always affects only the large intestine.

The cause of Crohn Disease is not known for certain, but many researchers believe that a dysfunction of the immune system causes the intestine to overreact to an environmental, dietary, or infectious agent. Certain people may have a hereditary predisposition to this immune system dysfunction. Cigarette smoking seems to contribute to both the development and the periodic flare-ups (bouts or attacks) of Crohn Disease. Oral contraceptives may increase the risk of Crohn Disease.

Symptoms

The most common symptoms of Crohn Disease are:

  • Crampy abdominal pain
  • Chronic diarrhea (which sometimes is bloody when the large intestine is severely affected)
  • Fever
  • Loss of appetite
  • Weight loss
  • Inflammation of the joints (arthritis)
  • Inflammation of the whites of the eyes (episcleritis)

Symptoms of Crohn Disease may continue for days or weeks and may resolve without treatment. Complete and permanent recovery after a single attack is extremely rare. Crohn Disease almost always flares up at irregular intervals throughout a person’s life. Flare-ups can be mild or severe, brief or prolonged. Severe flare-ups can lead to intense, constant pain, fever, and dehydration.

Why the symptoms come and go and what triggers new flare-ups or determines their severity is not known. Recurring inflammation tends to appear in the same area of the intestine, but it may spread to adjacent areas after a diseased segment has been removed surgically.

In children, abdominal pain and diarrhea often are not the main symptoms and may not appear at all. Instead, the main symptoms may be slow growth, joint inflammation (arthritis), fever, or weakness and fatigue resulting from anemia.

Symptoms and signs vary according to the affected site and how much of the gut is involved. If the small bowel is involved, patients may get abdominal pain after meals, diarrhea and weight loss. With large bowel involvement, diarrhea and rectal bleeding is common.

Symptoms in Crohn’s Disease may begin insidiously and the diagnosis is often delayed. Systemic features are common (fever, weight loss, etc) and perianal disease (lesions, abscesses) is a frequent early clue to the diagnosis.

Treatment

Crohn Disease has no known cure and is characterized by intermittent flare-ups of symptoms. Flare-ups may be mild or severe, few or frequent. With proper treatment, most people continue to lead productive lives.

  • Antidiarrheal drugs
  • Aminosalicylates
  • Corticosteroids
  • Immunomodulating drugs
  • Biologic agents
  • Antibiotics
  • Dietary regimens
  • Sometimes surgery

Many treatments of Crohn disease help reduce inflammation and relieve symptoms.

Diagnosing Crohn’s Disease

The diagnosis is made by a combination of x-rays, endoscopy, colonoscopy and biopsies. A doctor may suspect Crohn Disease in a person with recurring crampy abdominal pain and diarrhea, particularly if the person has a family history of Crohn Disease or a history of problems around the anus. Other clues to the diagnosis may include inflammation in the joints, eyes, or skin or stunted growth in a child. The doctor may feel a lump or fullness in the lower part of the abdomen, most often on the right side.

Blood and stool tests

No laboratory test specifically identifies Crohn Disease, but blood tests may show anemia, abnormally high numbers of white blood cells, low levels of the protein albumin, and other indications of inflammation, such as an elevated erythrocyte sedimentation rate or level of C-reactive protein. A doctor may also do tests to determine how the liver is functioning. If diarrhea is present, a doctor may collect stool samples to rule out certain infections.

Imaging tests

People who have severe abdominal pain and tenderness often have a computed tomography (CT) scan or magnetic resonance imaging (MRI) of their abdomen. CT or MRI may show a blockage, abscesses or fistulas, and other possible causes of inflammation of the abdomen (such as appendicitis).

People who have had symptoms that recur over a period of time may have x-rays taken of the stomach and small intestine after drinking liquid barium (called an upper gastrointestinal [GI] series) or have x-rays taken after receiving barium as an enema (called a barium enema). Newer approaches include CT enterography or magnetic resonance enterography. Another way in which the small intestine can be evaluated is with video capsule endoscopy.

Colonoscopy

People who have little pain and mostly diarrhea undergo a colonoscopy (an examination of the large intestine with a flexible viewing tube) and a biopsy (removal of a tissue specimen for microscopic examination). If Crohn Disease is limited to the small intestine, colonoscopy is detected by advancing the colonoscopy all the way through the colon and into the last part of the small intestine where the inflammation most often resides.

IMPORTANT HEALTH NOTE

We recommend that people experiencing gastrointestinal symptoms do not attempt self-treatment. With many medications being available over the counter, and numerous do-it-yourself online unqualified remedy recommendation, it is natural to consider treating yourself but we highly recommend against this.

If you are experiencing gastrointestinal symptoms you may have a more significant issue than you would expect from the sometimes muted or infrequent symptom you may be experiencing. It is important to keep in mind that is you are having gastrointestinal symptoms or concerns it is best see a doctor to have those symptoms diagnosed and any conditions treated. Also, it is worth noting, that if health conditions do exist, the earlier they are diagnosed and treated, the greater the probability will be to successfully eliminate or manage a present condition, in fact successful outcomes will increase significantly with early detection.

If you have gastrointestinal concerns or are experiencing any gastrointestinal symptoms, please contact us promptly to schedule a consultation with a physician.


DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way, does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a best in class physician regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today at (215) 321-4700 to schedule a consultation.